💬 Enrolment SMS:

Once the patient has accessed the link, they will be prompted to enter their date of birth in order to access the questionnaire 📆


1. Do you know the name of the contraceptive pill you want?

  • Yes

  • No

  • No, but I want the same one I was given last time

(If Yes)

2. What is the name of the contraceptive pill you are requesting a repeat prescription for?

  • Type your answer here

(If No/No, but I want the same one I was given last time and when they have answered the last question for yes)

3. Have you been diagnosed with any new health conditions since we last issued you a prescription for the Pill?

(These could be any conditions but in particular: heart disease, stroke, breast cancer, liver disease)

  • Yes

  • No

(If Yes)

4. What new health conditions have you been diagnosed with since your last prescription?

  • Type your answer here

(If No and after answering the questions asked if yes to new conditions)

5. Have you experienced any changes to your bleeding pattern that are worrying you (such as unexpected spotting, or after sex)?

  • Yes

  • No

(If Yes)

6. Are you up-to-date with your cervical screening (smear test)?

  • Yes

  • No

7. Are you interested in having any sexual health screening?

(This could be important as the oral contraceptive pill does not protect against sexually transmitted infections)

  • Yes

  • No

8. What is your current smoker status?

  • Current Smoker

  • Ex-smoker

  • Never smoked

(If a current smoker)

9. How much do you smoke?

  • <1 cigarette or equivalent per day

  • 1-9 cigarettes or equivalent per day

  • 10-19 cigarettes or equivalent per day

  • 20-39 cigarettes or equivalent per day

  • 40+ cigarettes or equivalent per day

After answering how much they smoke or if they are an ex-smoker or have never smoked they will be asked:

10. Are you able to provide a blood pressure reading?

(To safely prescribe the contraceptive pill, it is important that we have an up-to-date blood pressure reading)

  • Yes

  • No

(If yes the questionnaire provides the following information)

Before you take your blood pressure reading:

  • Sit down comfortably for 5 minutes.

  • Wear loose-fitting clothing

  • Make sure your arm is around the same level as your heart

  • Make sure your arm is relaxed

When taking your blood pressure:

  • Put the cuff on following the instructions which came with your blood pressure monitor.

  • Keep still and silent.

Other Tips:

  • Take at least three readings, each two minutes apart.

  • Your first reading may be much higher than the next readings. If this is the case, keep taking readings until they level out and stop falling. Use this as your reading.

Please seek urgent medical attention if you develop any of the following:

  • Blood pressure is 170/115 or above (despite repeating it at least 2 times)

  • Chest pain

  • Changes in vision

  • Confusion

  • Severe headache

If you want more tips or to learn more, see the British Heart Foundation website.

11. Please enter your systolic (SYS) blood pressure reading. This is the top reading.

  • Answer

12. Please enter the diastolic (DIA) blood pressure reading. This is the lower reading. Note: This is not the pulse.

  • Answer

13. Do you know your weight?

  • Yes (Will be asked to provide weight in kilograms)

  • No

14. Do you know your height?

  • Yes (Will be asked for height in centimeters)

  • No

15. Is there anything else regarding the contraceptive pill that you would like us to know?

  • Type your answer here

When they have submitted their answers they will be thanked for completing the survey and sent a confirmation SMS 👇

If a smoker this page will also include:

Smoking cessation advice

Smoking leads to health problems such as cancer, heart disease and strokes. The benefits of stopping smoking include: better health, more money and cleaner air for those around you!

Do you want to stop smoking? Here is some advice on ways to quit smoking, local services and general tips: nhs.uk/smokefree

Response in the Accurx Desktop toolbar: POP Team 👇

Please then select the save to record button if you wish for these results to be saved to the patient's medical record 📚

SNOMED codes saved to record

The codes added are in bold and italics

The following codes are also saved according to the patient's response:

"What is your smoking status?"

  • "Current smoker" - Current smoker

  • "Ex-smoker" - Ex-smoker

  • "Never smoked" - Never smoked

[if chose 'Current Smoker' above] Smoking: "How much do you smoke?"

  • "Trivial smoker (<1 cigarettes/day or equivalent)" - Trivial smoker (<1 cigarettes/day or equivalent)

  • "Light smoker (1-9 cigarettes/day or equivalent)" - Light smoker (1-9 cigarettes/day or equivalent)

  • "Moderate smoker (10-19 cigarettes/day or equivalent)" - Moderate smoker (10-19 cigarettes/day or equivalent)

  • "Heavy smoker (20-30 cigarettes/day or equivalent)" - Heavy smoker (20-30 cigarettes/day or equivalent)

  • "Very heavy smoker (40+ cigarettes/day or equivalent)" - Very heavy smoker (40+ cigarettes/day or equivalent)

Smoking cessation advice given - This code is added for anyone who says they are a current smoker. We display a standard short bit of smoking cessation advice with link to nhs.uk/smokefree.

  • Systolic arterial pressure - 72313002

  • Diastolic arterial pressure - 1091811000000102

  • Weight - 162763007

  • Height - 162755006

  • BMI - 60621009

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